Medicare

Part D premiums rise 24 percent

Tracy Staton — Fri, 26 Sep 2008 10:01:26 -0400

The pharma friend that is Medicare Part D will be more expensive for seniors next year. On average, premiums for the 10 most popular drug-coverage plans will leap by 31 percent. And for all standalone drug plans, the average price hike amounts to 24 percent, to $37 monthly. Meanwhile, Center for Medicare Services chief Kerry Weems is warning that plans may have made "significant" changes in coverage, and he urges seniors to carefully scrutinize their drug plans.

One area that Weems pointed out was drug coverage during the "gap"--the so-called donut hole where benefits drop off once seniors have spent $2,510 on meds. Beneficiaries can buy extra coverage to span the gap, but at an additional cost, of course.

Health plans are blaming their own inaccurate forecasting for increased premiums and coverage cuts. "If [premium] prices are increasing more on the midlevel plans, it's simply because our experience tells us that's where we need to be--premium-wise--to cover our actual costs plus a small margin," a Humana spokesman said. And UnitedHealth Group blamed high Medicare drug costs for its poor earnings this year.

- see the story at WebMD
- read the Wall Street Journal's article

Medicare overpays for new generics

Tracy Staton — Thu, 28 Aug 2008 11:13:26 -0400

When generics hit the market, the price drops. That's conventional wisdom. But in the case of Medicare, it's not always true. According to a new report from the Health and Human Services inspector general, the formula Medicare uses to pay for certain drugs doesn't incorporate the new price for months.

Take Camptosar, Pfizer's cancer drug that went generic in February. In March, Medicare paid $126 per dose, despite the fact that the average generic price for it was only $41--and the average price for both the generic and branded versions the same month was only $52. Even now, Medicare is still paying $75.

The IG suggests that Medicare figure out how to pay less, sooner. Even if that means changing the laws that determine what Medicare pays for drugs.

- read the WSJ Health Blog item

Medicare peeved by PBM markups

Tracy Staton — Tue, 22 Jul 2008 10:06:28 -0400

Medicare wants to curb lock-in drug pricing, under which some pharmacy benefits managers mark up drugs they sell to health insurers--and ultimately, the government. Report

Medicare drug coverage costs more this year

Tracy Staton — Thu, 05 Jun 2008 07:59:53 -0400

Most seniors in Medicare's prescription-drug program are paying considerably higher monthly premiums this year, according to a new study; we'll have to wait and see whether the higher costs force seniors to drop coverage--and in turn, some of their prescription drugs. Report

Avastin-Lucentis trial may reshape pharma

Wed, 14 May 2008 06:59:56 -0400

We thought the head-to-head trial of Avastin and Lucentis for age-related macular degeneration was a big deal for Genentech, which makes both drugs. Now, IMS Health is saying that the trial could be "a Pandora's box" for the entire pharma industry.

Conducted by the National Eye Institute, part of the National Institutes of Health, the trial is designed to see whether the much cheaper Avastin, often used off-label to treat AMD, measures up to the AMD-specific--and very expensive--Lucentis. If Avastin passes muster, then prescribers may desert Lucentis completely. And if docs don't do so voluntarily, then insurers and other payers may nudge, cajole, incentivize, or downright push them to.

And there's the rub, IMS says. By taking the drugmaker out of the testing, this trial could fundamentally reshape relations between payers and pharma. Payers could sponsor comparative drug studies of their own or lobby the government to do so, IMS theorizes, especially as databases make those comparisons easier. There's plenty of time to worry about it, though: The Avastin-Lucentis trial won't wrap till 2010.

- see the story in the Financial Times

Congress probes Amgen, J&J promos

Tue, 01 Apr 2008 07:59:55 -0400

Did Amgen and Johnson & Johnson over-promote their anemia drugs? Congress is asking the companies for documents detailing their advertising and promotions, including a "bundling" discount Amgen allegedly offered to doctors on Neupogen and Neulasta in return for Aranesp scrips. "We are concerned that such 'bundling' practices may have helped fuel excessive and dangerous off-label use of Aranesp," Rep. John Dingell wrote to Amgen in a letter demanding the documents.

Meanwhile, Dingell's Energy and Commerce Committee is also asking J&J for records on its DTC ads for Procrit, which claimed the med could offer "strength for living."

The ad/promo investigation comes at a time when the anemia drugs have been under scrutiny for safety risks. The meds have been linked to increased risk of death at high doses, and have been linked to tumor growth and death risk in certain cancer patients.

- see Dingell's letter to J&J (.pdf)
- check out Dingell's Amgen letter (.pdf)
- read the Boston Globe article

Related Articles:
Amgen--Big Biotech's Stock Report. Report
FDA's worst-case anemia scenario. Report
Do anemia warnings signal new limits? Report
Study: Anemia meds hike death risk 10%. Report
New Medicare cap on anemia drugs could hammer Amgen. Report
FDA: More risks from anemia drugs. Report

NIH launches Avastin-Lucentis trial

Mon, 25 Feb 2008 06:59:57 -0500

Gentlemen (and ladies), start your eye injections. In other Avastin news, the big trial pitting the cancer drug against Genentech sister med Lucentis is now underway. Sponsored by the National Institutes of Health, the independent trial is designed to show how the two meds stack up in treating age-related macular degeneration.

Lucentis has been FDA-approved for use against wet AMD. Though Avastin isn't, eye docs have commonly used it off-label, saying it's almost as effective as Lucentis, if not as effective. And Avastin costs much less: hundreds per treatment versus thousands.

The sticking point has been that, to use Avastin in the eye, it had to be repackaged by compounding pharmacists. Genentech moved last year to restrict supplies to those pharmacies, saying that the FDA was concerned about the repackaging. But Genentech had no plans to study Avastin for macular degeneration, preferring to push its already-approved and more expensive Lucentis.

So the NIH is doing it for them. After all, because macular degeneration tends to be a disease of the elderly, it's Medicare paying for much of the treatment. So the government has a vested interest in proving the cheaper treatment is a viable alternative.

- read the press release from the NIH
- see the story in the Wall Street Journal

Related Articles:
Genentech rethinks Avastin limits. Report
Eye docs confront Genentech exec. Report
Why should Medicare pay for Lucentis? Report
Genentech to curb Avastin sales. Report
Doctors balancing effects, costs of Lucentis and Avastin. Report

AZ to appeal$215M Alabama judgment

Fri, 22 Feb 2008 06:59:54 -0500

A jury hit AstraZeneca with $215 million in damages as paybacks for overcharging the state of Alabama for drugs for 15 years. And AstraZeneca is just the first of 70 drug makers to go to trial. In 2005, Attorney General Troy King sued scores of pharma companies over Medicaid prices, and has settled with only two--Dey and Takeda Pharmaceuticals--which agreed to pay $6.75 million.

AstraZeneca says it's appealing the decision posthaste. The court allowed evidence from earlier pricing settlements "in clear violation of the rules of evidence," the company says. Plus, AstraZeneca claims, trial lawyers and state officials prejudiced potential jurors by making "negative public comments" before jury selection.

- check out AstraZeneca's release
- read this report
- see the item at Pharmalot

Related Article:
Drug companies must pay for Medicare pricing scheme. Report

Medicare: Right to restrict anemia meds

Mon, 11 Feb 2008 06:59:58 -0500

A Medicare official says there's an even better case now for restricting payments for Amgen and Johnson & Johnson's big anemia drugs. According to the agency's chief medical officer, two more studies have cast doubt on the safety of Aranesp, Epogen, and Procrit, which together generated more than $5 billion in sales in 2007. The drugs are one of the biggest prescription costs for Medicare.

You'll recall that last year, the Centers for Medicare and Medicaid Services restricted its reimbursements for the drugs, after four studies suggested various safety problems, including a higher risk of death for patients using them. Now, the FDA has scheduled a hearing to consider two more studies that suggest the drugs are even more risky for some cancer patients. The companies and the American Society of Clinical Oncology continue to submit evidence for their argument that restricting the anemia drugs will only lead to an increase in blood transfusions.

- read the item at Pharmalot

Related Articles:
New Medicare cap on anemia drugs could hammer Amgen. Report
Amgen income hammered as anemia drug use drops. Report
FDA: More risks from anemia drugs. Report
Analyst: Anemia drug warnings 'not bad'. Report

Canada to decide Lucentis' fate

Wed, 23 Jan 2008 06:59:56 -0500

The Lucentis versus Avastin match has moved to Canada. Officials there are arguing whether to pay the tens of thousands of dollars a year for Lucentis, the Genentech-made and Novartis-marketed drug that's approved to treat wet macular degeneration. Or should they instead reimburse for Avastin, another Genentech-made drug that's shown to be effective against WMD and is much cheaper to boot--but isn't approved by HealthCanada for that use.

Since Lucentis wasn't available in Canada until recently, eye specialists have been using Avastin against WMD. Many have reported success. But Genentech hasn't studied the drug in WMD, and a U.S. NIH study won't be complete until 2010. So provincial and federal health plans can't pay for the drug when it's used against WMD.

The federal panel responsible for deciding which drugs should be covered rejected Lucentis late last year. At Novartis' request, the group is reconsidering that application, and a decision may be announced as early as today. Novartis is pushing hard for the approval; alongside it is the Canadian National Institute for the Blind, which got a grant from the drugmaker and is using some of those funds to campaign for Lucentis.

You'll recall that a similar debate has been raging in the U.S. Genentech had tried to cut off Avastin supplies to the compounding pharmacies that repackage it for eye use, but ophthalmologists protested and the company agreed to keep some supply channels open to eye docs.

- read the The Globe and Mail report